Even the most experienced nurses occasionally have trouble finding veins in patients. It can be especially difficult when placing an IV in an infant or small child. In some situations, it may take two or three tries to start a proper line. But in emergencies, the difference between starting a line now and in a few minutes could be a matter of life or death. Nurses looking to advance their careers by making the transition to the ER or to the maternity ward would do well to brush up on their vein-finding skills. Plus, it's good practice for anyone in the profession.
Here are a few simple tips to help you find a vein and start a line on the first try:
1. Use sight and touch
When selecting a vein for an IV, it's best to get two senses involved. Rather than spotting a vein and attempting to start a line right way, use your fingers to lightly run over the vein. You should be feeling to understand if the vein will roll, and if so, in what direction. Veins that roll too far can make starting an IV extremely difficult. As EMS Office Hours noted, you don't want to apply too much pressure, because it can cause the veins to shrink away from the surface of the skin and tighten up.
2. Limit tourniquet use
When learning how to start an IV and how to find veins, nurses might have worked with tourniquets for longer periods, leaving them on the patient for several minutes as they searched for the right vein. In a clinical setting, you want to limit tourniquet use to two minutes. If you find that it takes too long, consider switching the tourniquet to the other arm or letting the veins rest for a few moments. In a critical situation, it may be necessary to start the IV in the hand or leg instead of the arm.
3. Consider using a PICC line
A study conducted by Susan Gallagher Camden PhD, MSN, MA, RN, CBN, of the University of Southern California found that it can be challenging to start an IV in obese patients. This can very frustrating when intravenous access is required multiple times in a day. Camden suggested using a peripherally-inserted central catheter (PICC) in these situations. The PICC line is safe to stay in the vein for weeks at a time, meaning you won't have to search for veins multiple times. Check out the example below:
4. Focus on moving the catheter
One of the most important things to remember is that, once you've found the vein with the needle it's not over yet. When moving the catheter down, you could still lose the vein if you bump the needle out of the place. EMS Office Hours explained that you need to keep your needle hand absolutely still during this process – nudge the catheter down without moving the needle. Once it's down, carefully retract the needle, then dispose of it in the sharps bin.